Bruge Phillipe, Jabre Patricia, Dru Michel, Jbeili Chadi, Lecarpentier Eric, Khalid Mohamed, Margenet Alain, Marty Jean, Combes Xavier
SAMU 94, CHU H Mondor (AP-HP), 94000 Créteil, France.
Am J Emerg Med. 2008 Feb;26(2):165-9. doi: 10.1016/j.ajem.2007.04.022.
Out-of-hospital clinical experience with noninvasive bilevel positive airway pressure (BiPAP) ventilation is extremely limited compared to inhospital management. The aims of this study were to assess the feasibility of out-of-hospital BiPAP ventilation in patients with acute respiratory distress of various origins, and to look for specific factors associated with failure of this respiratory support.
This 2-year prospective observational study assessed the failure rate of out-of-hospital BiPAP ventilation, the difficulties encountered, and factors predictive of failure by multivariate analysis.
Overall, 138 patients were treated by out-of-hospital BiPAP for congestive heart failure (56%), chronic obstructive pulmonary disease exacerbation (28%), and acute respiratory failure (16%). Failure rate was 26% (35/138; 95% confidence interval, 18%-33%) (11 before and 24 after reaching hospital). Independent risk factors were the cause of respiratory distress (chronic obstructive pulmonary disease exacerbation; acute respiratory failure) and an audible air leakage.
The failure rate of BiPAP initiated out-of-hospital was no different from previous reports for inhospital failure rates. Failure was attributable to similar causes.
与院内管理相比，院外无创双水平气道正压通气（BiPAP）的临床经验极为有限。本研究旨在评估院外BiPAP通气在各种病因所致急性呼吸窘迫患者中的可行性，并寻找与这种呼吸支持失败相关的特定因素。
这项为期2年的前瞻性观察性研究评估了院外BiPAP通气的失败率、遇到的困难以及通过多变量分析预测失败的因素。
总体而言，138例患者接受了院外BiPAP治疗，病因包括充血性心力衰竭（56%）、慢性阻塞性肺疾病急性加重（28%）和急性呼吸衰竭（16%）。失败率为26%（35/138；95%置信区间，18%-33%）（到达医院前11例，到达医院后24例）。独立危险因素为呼吸窘迫的病因（慢性阻塞性肺疾病急性加重；急性呼吸衰竭）和可闻及的漏气。
院外启动BiPAP的失败率与既往报道的院内失败率无差异。失败原因相似。
